Funding: The authors are each paid a salary by the Public Library of Science, and they
wrote this editorial during their salaried time.

Competing interests: The authors' individual competing interests are at http://www.plosmedicine.org/static/editorsInterests.action. PLoS
is funded partly through manuscript publication charges, but the PLoS
Medicine Editors are paid a fixed salary (their salary is not
linked to the number of papers published in the journal).

This month PLoS Medicine publishes a research article reporting that
medical doctors and mental health professionals from the US Department of Defense
working at the Guantánamo Bay prison concealed or failed to document medical
evidence of intentional harm of nine detainees [1].

The authors—Vincent Iacopino, a senior medical advisor to Physicians for Human
Rights, and Stephen Xenakis, a retired US Army Brigadier General—present a
case series of nine individuals detained in Guantánamo Bay, all of whom
alleged torture and ill treatment during detention at the facility. Acting as
nongovernmental medical personnel recruited by lawyers acting for the nine
detainees, the authors scrutinized medical records, client affidavits,
attorney–client notes and summaries, and legal declarations of medical experts
for evidence of torture and ill treatment. Where such evidence existed, Iacopino and
Xenakis assessed whether medical personnel at the camp had either documented or
treated symptoms arising from torture.

Guantánamo Bay is a detention facility for US prisoners in Cuba that opened in
2002. Despite US President Barack Obama pledging during the 2008 presidential
elections to shut Guantánamo Bay and transfer detainees to the US for trial,
the prison shows no sign of closing [2] and 172 detainees remain incarcerated there. Both authors
of the paper, which publishes this week, are from Physicians for Human Rights, a US
not-for-profit organization dedicated to mobilizing health professionals to
investigate and stop human rights abuses, that has previously documented in a series
of extensive reports evidence of the involvement of US personnel in torture at
Guantánamo Bay and other prisons worldwide [3],[4],[5].

This research article adds solid, specific evidence of both human rights abuses at
Guantánamo Bay and the apparent complicity of medical personnel in the abuse.
It documents specific features of torture alleged by the detainees including
“enhanced interrogation techniques” that were deemed suitable for use in
US interrogations by then-President George W. Bush [6]. These techniques included sleep
deprivation, exposure to temperature extremes, serious threats, forced positions,
beatings, and forced nudity. In addition, each of the nine detainees reported being
subjected to severe beatings, sexual assault and/or the threat of rape, mock
execution, mock disappearance, and being choked. By analyzing medical records and
carrying out psychological evaluations, either directly or by proxy, the authors of
the PLoS Medicine paper were able to detail the physical and mental
health of each detainee. Crucially, although some of the physical injuries sustained
by detainees that were consistent with allegations of torture were documented by
medical personnel in the camp, causes of injury were not
investigated by those personnel. Furthermore, mental health practitioners in the
camp recorded symptoms characteristic of post-traumatic stress disorder (PTSD) in
seven of nine detainees, but failed to investigate the causes of the symptoms or to
diagnose or treat the detainees' PTSD.

Iacopino and Xenakis reach a sobering conclusion: “Medical doctors and mental
health personnel assigned to the US Department of Defense neglected and/or concealed
medical evidence of intentional harm. The full extent of medical complicity in US
torture practices will not be known until there is a thorough, impartial
investigation including relevant classified information. We believe that, until such
time as such an investigation is undertaken, and those responsible for torture are
held accountable, the ethical integrity of medical and other healing professions
remains compromised.”

These findings are of course at stark odds with the codes of international medical
associations, which prohibit physicians from participating in or being present
during torture or other degrading procedures [7],[8]. Their findings especially
violate the American Medical Association's stance that specifically charges
physicians with providing assistance to victims of torture, and to “whenever
possible, strive to change situations in which torture is practiced or the potential
for torture is great” [8].

Publishing peer-reviewed documentary evidence of harm—especially from settings
difficult to access such as prisons or conflict settings—is a vital and
important role of medical journals. This paper adds new evidence that will bolster
calls for further investigation into the complicity of medical personnel in torture
at Guantánamo Bay, which clearly breaches fundamental human rights. Evidence
must be obtained and properly reported in order that those who have been negligent
(or worse) can be appropriately dealt with, including where necessary by
prosecution.

Author Contributions

Wrote the first draft: SJ. Contributed to the writing of the paper: VB JC EV
MN.